Co-Leaders of Cedars-Sinai Lymphoma Program Opening New Frontiers in Diagnosis, Treatment and Translational Research

Less than three years after joining the Cedars-Sinai Cancer faculty, hematologist-oncologists Justin Darrah, MD, and Akil Merchant, MD, are pioneering new research and bringing a new, comprehensive set of treatment options to patients in the recently established Lymphoma Program.

Darrah also directs the CAR T-Cell Program at Cedars-Sinai, and his focus is on clinical patient care. Merchant, who leads the Imaging Mass Cytometry Shared Resource, is a National Institutes of Health-funded physician-scientist with a focus on developing new treatments for blood cancers.

“Dr. Merchant and Dr. Darrah have designed a program that goes beyond standard of care to offer lymphoma patients access to advanced therapies such as clinical trials, CAR T-cell therapy and stem cell transplant,” said Dan Theodorescu, MD, PhD, director of Cedars-Sinai Cancer and the PHASE ONE Distinguished Chair. “The program offers innovation with the use of molecular diagnostics to personalize patient care and will support basic and translational research that will lead to new lymphoma discoveries.”

Lymphoma is a term for cancers that begin in the lymph system, a system of thin tubes and nodes running throughout the body that produces white blood cells used to fight infection. Lymphoma has classically been divided into two types—Hodgkin lymphoma and non-Hodgkin lymphoma—but Merchant said lymphoma is really “many diseases” because there are dozens of known subtypes.

“The challenge is finding the right treatment to fit the patient,” Merchant said. “My lab is devoted to further characterizing known subtypes to more clearly define lymphoma, so that it is essentially a disease of one patient. Then we can tailor therapy to precisely that patient, based on that patient’s specific lymphoma and the mutations that are driving it.”

The Lymphoma Program offers a comprehensive range of experts—from hematologist-oncologists to experts in cellular therapy, pathologists and radiation oncologists—to take patients from diagnosis through treatment. The program also bridges clinical care and clinical trials, integrating what is learned during patient care into research and vice versa.

“We have a biobank, so patients can donate their specimens to our repository, and we get samples from all over the world,” Merchant said. “We analyze these samples in the lab, identify new targets for therapies, test those in preclinical studies, and then translate that into new clinical trials that we can offer to patients. The cycle of bench to bedside and back is active within our program.”

Clinical trials are an important component of the program.

“When discussing recommended treatment plans with our patients, I first discuss standard of care,” Darrah said. “And if a patient is eligible for a clinical trial, we then discuss that option as well. We strategically build trials so that they involve standard of care—the care the patient would otherwise receive—plus an additional drug that we think is going to add benefit. Data show that patients receive the best clinical care on clinical trials, so we want to be able to offer clinical trials to patients at every phase of their treatment.”  

One treatment option for patients with lymphoma is a bone marrow transplant, also called a stem cell transplant, where healthy bone marrow stem cells are transplanted into the bloodstream to rebuild the patient’s bone marrow. The Center for International Blood and Bone Marrow Transplant Research ranks the Blood and Bone Marrow Transplant Program at Cedars-Sinai in the top 10 of 173 programs in the U.S. for patient survival, making it one of the highest-ranked programs in the country.

Another option is CAR T-cell therapy, which uses a patient’s own immune system to fight the cancer. The patient’s immune cells are collected and then modified in the laboratory so that they will attack cancer cells. 

“We have dramatically expanded our CAR T-Cell Program for patients with lymphoma, leukemia and multiple myeloma,” said John Chute, MD, director of the Division of Hematology and Cellular Therapy at Cedars-Sinai. “The application of these leading-edge therapies and the superior outcomes for patients undergoing stem cell transplantation has increased annual transplant volumes at Cedars-Sinai 40% over the past four years,” Chute said. “They are projected to increase an additional 30% in 2022.”

Darrah and Merchant also are working to expand the advanced lymphoma care that the Lymphoma Program offers to patients throughout California.

“We want to extend these services to places beyond the Los Angeles metropolitan area to areas where patients don’t currently have access to comprehensive lymphoma care,” Darrah said. “We’re exploring a program that will allow us to offer many services virtually to patients who would otherwise have to travel great distances. These are often underserved communities, and bringing excellent care to these patients is core to the Cedars-Sinai Cancer mission, and what motivates us personally as physicians.”